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Thioplex Side Effects

Generic Name: thiotepa

Note: This page contains side effects data for the generic drug thiotepa. It is possible that some of the dosage forms included below may not apply to the brand name Thioplex.

For the Consumer

Applies to thiotepa: injection powder for solution

Along with their needed effects, medicines like thiotepa (the active ingredient contained in Thioplex) can sometimes cause unwanted effects such as blood problems, loss of hair, and other side effects. These and others are described below. Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia. Discuss these possible effects with your doctor.

Although not all of these side effects may occur, if they do occur they may need medical attention.

Major Side Effects

If any of the following side effects occur while taking thiotepa, check with your doctor immediately:

Less common:
  • Black, tarry stools
  • blood in urine or stools
  • cough or hoarseness
  • fever or chills
  • lower back or side pain
  • painful or difficult urination
  • pinpoint red spots on skin
  • unusual bleeding or bruising
  • Skin rash
  • tightness of throat
  • wheezing

Severity: Moderate

If any of the following side effects occur while taking thiotepa, check with your doctor or nurse as soon as possible:

Less common:
  • Joint pain
  • pain at place of injection or instillation
  • swelling of feet or lower legs
  • Sores in mouth and on lips

Minor Side Effects

Some thiotepa side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Less common:
  • Dizziness
  • hives
  • loss of appetite
  • missing menstrual periods
  • nausea and vomiting

This medicine may cause a temporary loss of hair in some people. After treatment with thiotepa has ended, normal hair growth should return.

Side Effects: Post Treatment

After you stop taking this drug, it is possible that you may still experience side effects that need medical attention. If you notice any of the following side effects check with your doctor immediately:

  • Black, tarry stools
  • blood in urine or stools
  • cough or hoarseness
  • fever or chills
  • lower back or side pain
  • painful or difficult urination
  • pinpoint red spots on skin
  • unusual bleeding or bruising

For Healthcare Professionals

Applies to thiotepa: injectable powder for injection, intravenous powder for injection


Hematologic side effects have included bone-marrow depression, which is the most serious complication of excessive thiotepa (the active ingredient contained in Thioplex) therapy, or sensitivity to the effects of thiotepa. If proper precautions are not observed, leukopenia, thrombocytopenia and/or anemia may develop. The nadir in the leukocyte and platelet counts generally occur in 7 to 10 days and 21 days respectively.

Death has occurred after intravesical administration, caused by bone-marrow depression from systemically absorbed drug. However, if the drug is administered by intracavitary or intravesical injection, myelosuppression is not predictable. Death from septicemia and hemorrhage has occurred as a direct result of hematopoietic depression. Thiotepa is highly toxic to the hematopoietic system.

Pancytopenia has been reported. One case report was of early onset life-threatening pancytopenia following a total dosage of 120 mg.[Ref]

In one study of 670 bladder installations in 72 patients, the white blood cell or platelet count decreased to below normal in 18% of the patients (3.9% of the installations). None of these decreased counts lead to any problems other than delays in therapy.

New York Hospital reviewed its records of patients who received at least one intravesicular installation of thiotepa for localized bladder cancer. Ten of 25 consecutive patients had at least one episode of acute myelosuppression. Thrombocytopenia occurred in 9 patients, leukopenia in 5, and anemia in 2.[Ref]


Oncologic side effects have included cases of myelodysplastic syndromes and acute nonlymphocytic leukemia. Carcinogenicity has been reported in animal studies.[Ref]

In mice, repeated IP administration produced a significant increase in the combined incidence of squamous-cell carcinomas of the skin, preputial gland, and ear canal, and combined incidence of lymphoma and lymphocytic leukemia. In other studies in mice, repeated IP administration resulted in an increased incidence of lung tumors. In rats, repeated IP administration produced significant increases in the incidence of squamous-cell carcinomas of the skin or ear canal, combined hematopoietic neoplasms, and uterine adenocarcinomas. Thiotepa given intravenously to rats produced an increased incidence of malignant tumors (abdominal cavity sarcoma, lymphosarcoma, myelosis, seminoma, fibrosarcoma, salivary gland hemangioendothelioma, mammary sarcoma, pheochromocytoma) and benign tumors. The lowest reported carcinogenic dosages in mice and rats are approximately 7-fold and 6-fold less than the maximum recommended human therapeutic dose based on body-surface area.[Ref]


General side effects including fatigue and weakness have been reported. Febrile reaction and discharge from a subcutaneous lesion may occur as the result of breakdown of tumor tissue.[Ref]


Allergic reactions including rash, urticaria, laryngeal edema, asthma, hives, anaphylactic shock, and wheezing have been reported.[Ref]


Local reactions including contact dermatitis and pain at the injection site have been reported.[Ref]


Gastrointestinal side effects including nausea, vomiting, and anorexia have been reported. Abdominal pain has been reported, particularly after intravesical administration.[Ref]


Renal side effects including dysuria and urinary retention have been reported. There have been rare reports of chemical or hemorrhagic cystitis following intravesical administration.[Ref]

A case of renal failure due to a reaction causing urethral obstruction (following a bladder installation) has been reported.[Ref]


Respiratory side effects including prolonged apnea has been reported when succinylcholine was administered prior to surgery, followed by the combined use of thiotepa (the active ingredient contained in Thioplex) and other anticancer agents.[Ref]

Nervous system

Neurologic side effects including dizziness, headache, blurred vision, lower extremity weakness, pain, and paresthesia have been reported. Spinal cord demyelination may occur after intrathecal administration.[Ref]


Dermatologic side effects including alopecia and dermatitis have been reported. Skin depigmentation has been reported following topical use.[Ref]


Genitourinary side effects including amenorrhea, interference with spermatogenesis and sterility have been reported.[Ref]


Ocular side effects including conjunctivitis have been reported. Following ocular administration, periorbital depigmentation has been reported.[Ref]


An in vitro study has shown that the drug causes chromosomal aberrations of the chromatid type and that the frequency of induced aberrations increases with the age of the subject.[Ref]

Other side effects include a mutagenic effect in vitro assays including those on human lymphocytes.[Ref]


1. "Multum Information Services, Inc. Expert Review Panel"

2. Agnelli G, de Cunto M, Gresele P, del Favero A "Early onset life-threatening myelosuppression after low dose of intravesical thiotepa." Postgrad Med J 58 (1982): 380-1

3. Kottmeier HL "Treatment of ovarian cancer with thiotepa." Clin Obstet Gynecol 11 (1968): 428-38

4. Watkins WE, Kozak JA, Flanagan MJ "Severe pancytopenia associated with the use of intravesical thio- TEPA." J Urol 98 (1967): 470-1

5. Soloway MS, Ford KS "Thiotepa-induced myelosuppression: review of 670 bladder instillations." J Urol 130 (1983): 889-91

6. Newell DR, Gore ME. Toxicity of alkylating agents: clinical characteristics and pharmacokinetic determinants. In: Powis G and Hacker MP, eds. "The Toxicity of Anticancer Drugs." New York, NY: Pergamon Press (1991): 44-62

7. Hollister D Jr, Coleman M "Hematologic effects of intravesicular thiotepa therapy for bladder carcinoma." JAMA 244 (1980): 2065-7

8. Heideman RL, Packer RJ, Reaman GH, Allen JC, Lange B, Horowitz ME, Steinberg SM, Gillespie A, Kovnar EH, Balis FM, et al "A phase II evaluation of thiotepa in pediatric central nervous system malignancies." Cancer 72 (1993): 271-5

9. "Product Information. Thiotepa (thiotepa)." Lederle Laboratories, Wayne, NJ.

10. Batts CN "Adjuvant intravesical therapy for superficial bladder cancer." Ann Pharmacother 26 (1992): 1270-6

11. Schellhammer PF "Renal failure associated with the use of thio-tepa." J Urol 110 (1973): 498-501

12. Greenspan EM, Jaffrey I, Bruckner H "Thiotepa, cutaneous reactions, and efficacy." JAMA 237 (1977): 2288

It is possible that some side effects of Thioplex may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.